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Viedma-Martínez M, Millán-Cayetano JF, Grassi-García C, Linares-Barrios M. Dermatofibrosarcoma Protuberans: Hospital Casuistry and Comparative Analysis in the Management of This Entity by the Dermatology Unit Compared to Other Units. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00254-0. [PMID: 38552782 DOI: 10.1016/j.ad.2023.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 05/26/2024] Open
Affiliation(s)
- M Viedma-Martínez
- Departamento de Dermatología, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - J F Millán-Cayetano
- Departamento de Dermatología, Hospital Universitario Puerta del Mar, Cádiz, España
| | - C Grassi-García
- Departamento de Cirugía Plástica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - M Linares-Barrios
- Departamento de Dermatología, Hospital Universitario Puerta del Mar, Cádiz, España
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2
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Gonzalez Díaz C, Olmos Perez M, Guiot Isaac N, Herazo Aguirre I. Dermatofibrosarcoma Protuberans: A Series of 14 Patients in Whom High-Resolution Ultrasound Was the Key to Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:312-315. [PMID: 37848133 DOI: 10.1016/j.ad.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/24/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- C Gonzalez Díaz
- Radióloga, experta en ultrasonido Dermatológico, Bogotá, Colombia
| | - M Olmos Perez
- Dermatólogo, especialista de cirugía dermatológica, docente FUCS, Bogotá, Colombia
| | - N Guiot Isaac
- Residentes de último año dermatología FUCS, Bogotá, Colombia.
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Gonzalez Díaz C, Olmos Perez M, Guiot Isaac N, Herazo Aguirre I. [Translated article] Dermatofibrosarcoma Protuberans: A Series of 14 Patients in Whom High-Resolution Ultrasound Was the Key to Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T312-T315. [PMID: 38224735 DOI: 10.1016/j.ad.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/24/2023] [Indexed: 01/17/2024] Open
Affiliation(s)
- C Gonzalez Díaz
- Radióloga, experta en ultrasonido Dermatológico, Bogotá, Colombia
| | - M Olmos Perez
- Dermatólogo, especialista de cirugía dermatológica, docente FUCS, Bogotá, Colombia
| | - N Guiot Isaac
- Residente de último año dermatología FUCS, Bogotá, Colombia.
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Haddadi S, El Mammeri M, Bouache Y, Ourdane R, Touati R. [Fascio-cutaneous exeresis of a dermatofibrosarcoma of Darier-Ferrand of the right flank]. ANN CHIR PLAST ESTH 2024; 69:97-100. [PMID: 37045655 DOI: 10.1016/j.anplas.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/15/2023] [Accepted: 03/25/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Darrier-Ferrand dermatofibrosarcoma (DFSC) is the most common cutaneous sarcoma. It generally affects subjects with an average age of 40 years, without gender or race predominance. It is a tumour characterised by a slow evolution and local aggressiveness. The reasons for consultation are pain, pruritus or rapidly progressive evolution. There are no specific imaging studies for this tumour. The diagnosis of certainty is based on immunohistochemistry with positive CD34 labelling. Treatment is surgical based on wide excision. MATERIAL AND METHODS This is an observation of a patient operated in our department for the initial diagnosis of cutaneous leiomyosarcoma of the right flank that rapidly increased in volume to 10cm in six months. A large fasciocutaneous excision was performed. The postoperative course was simple. DISCUSSION In our patient, this lesion occurred on an old burn scar. This notion of skin trauma preceding the appearance of DFSC is reported in 10 to 20% of cases. The rapid increase in volume was the reason for consultation. The diagnosis of DFSC could only be made on definitive analysis of the surgical specimen, which showed positive immunostaining for CD34. The occurrence of metastases, although rare, confers a survival of no more than two years. The prognostic factors depend on the quality of the surgical excision, the presence of metastases and certain locations (head, neck), which make the surgery particularly mutilating. Only long-term monitoring attests to definitive cure, given the frequency of recurrence. CONCLUSION DFSC is a rare and slowly evolving tumour. Wide surgical excision should be attempted in most cases. In inoperable cases, the use of targeted therapies (IMATINIB) has led to complete cures in some cases.
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Affiliation(s)
- Saïd Haddadi
- Service de chirurgie générale A, hôpital central de l'Armée-Dr-Mohamed-Seghir Nekkache, BP 244 Aïn-Naadja, Alger, Kouba, Algérie.
| | - Makram El Mammeri
- Service de chirurgie générale A, hôpital central de l'Armée-Dr-Mohamed-Seghir Nekkache, BP 244 Aïn-Naadja, Alger, Kouba, Algérie.
| | - Yacine Bouache
- Service de chirurgie plastique et reconstructrice, hôpital central de l'Armée-Dr-Mohamed-Seghir-Nekkache, BP 244 Aïn-Naadja, Alger, Kouba, Algérie.
| | - Rabah Ourdane
- Service de chirurgie générale A, hôpital central de l'Armée-Dr-Mohamed-Seghir Nekkache, BP 244 Aïn-Naadja, Alger, Kouba, Algérie.
| | - Rezki Touati
- Service de chirurgie générale A, hôpital central de l'Armée-Dr-Mohamed-Seghir Nekkache, BP 244 Aïn-Naadja, Alger, Kouba, Algérie.
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Gangadhar SM, Yadav M, Mandal NS. Dermatofibrosarcoma Protuberans: A Surgeon's Enigma. Cureus 2023; 15:e44144. [PMID: 37753015 PMCID: PMC10518642 DOI: 10.7759/cureus.44144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a soft-tissue tumor arising from the dermis. It is a rare tumor, but the important point is that it has a higher incidence of local recurrence than other tumors. Management is primarily by wide local excision (WLE) with tumor negative margin (R0 resection) or Mohs micrographic surgery (MMS). In our case, a 57-year-old male patient presented with an anterior abdominal wall ulcerated mass. The patient had undergone surgery for the excision of the mass, twice before, at a different health-care facility. An incisional biopsy of the mass done at our hospital revealed it to be DFSP. The patient was treated by WLE with flap reconstruction. Post-operative histopathology examination (HPE) report confirmed DFSP with tumor-free margins (R0 resection). So if we fail to diagnose and manage DFSP correctly from the other commonly occurring tumors in the initial stages, there are very high chances of recurrence, and this causes significant morbidity to the patients.
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Affiliation(s)
- Siva M Gangadhar
- Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Mithilesh Yadav
- Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Nishith S Mandal
- Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Kuntz T, Siebdrath J, Hofmann SC, Baltaci M, Schaller J, Hellmich M, von Goltzheim LS, Assaf C, Oellig F, Michalowitz AL, Helbig D, Kreuter A. Increase of atypical fibroxanthoma and pleomorphic dermal sarcoma: a retrospective analysis of four German skin cancer centers. J Dtsch Dermatol Ges 2022; 20:1581-1588. [PMID: 36442137 DOI: 10.1111/ddg.14911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES In recent years, considerable insight has been gained into the pathogenesis, diagnosis and treatment of cutaneous sarcomas, including atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). Both entities have shown increasing incidence rates in the last decade. This study was initiated to evaluate how these new insights impact the number of diagnoses of AFX/PDS compared to other cutaneous sarcoma entities. PATIENTS AND METHODS In a retrospective study of four German skin cancer centers, all histopathological reports of cutaneous sarcomas (AFX, PDS, dermatofibrosarcoma protuberans, cutaneous leiomyosarcoma, angiosarcoma, and Kaposi sarcoma) confirmed by board-certified dermatopathologists were analyzed during a time-period of seven years (2013-2019). Additionally, utilization of immunohistochemical markers (including pan-cytokeratin, S100, desmin, CD34, CD10, procollagen-1, CD99, CD14, and CD68) as an adjunct to diagnose AFX/PDS was recorded. RESULTS Overall, 255 cutaneous sarcomas were included in the present study. The diagnosis of a cutaneous sarcoma has consequently risen from 2013 to 2019 (from 16 to 52 annual cases). The results of AFX/PDS revealed 4.6 times more diagnoses in 2019 than in 2013. Atypical fibroxanthoma represented the most common subtype, displaying 49.3 % of all diagnosed cutaneous sarcomas. Additionally, the increase of AFX/PDS was linked to the use of immunohistochemistry, with specific immunohistochemical markers used in 57.1 % of cases in 2013 compared to 100 % in 2019. CONCLUSIONS This retrospective study of four German skin cancer centers demonstrates a substantial rise of AFX/PDS, possibly due to recently established diagnostic and terminology standards. This rise is probably linked to increased utilization of specific immunohistochemical markers. Atypical fibroxanthoma/PDS may be more common than previously thought and seems to represent the most frequent cutaneous sarcoma subtype.
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Affiliation(s)
- Thomas Kuntz
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany.,Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Julian Siebdrath
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Silke C Hofmann
- Department of Dermatology, Allergology, und Dermatosurgery, HELIOS University Hospital Wuppertal, University of Witten-Herdecke, Wuppertal, Germany
| | - Mehmet Baltaci
- Department of Dermatology and Venereology, HELIOS Klinikum Duisburg, Duisburg, Germany
| | - Jörg Schaller
- Department of Dermatology and Venereology, HELIOS Klinikum Duisburg, Duisburg, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Luise Stach von Goltzheim
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Chalid Assaf
- Department of Dermatology and Venereology, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Frank Oellig
- Institute of Pathology, Mülheim an der Ruhr, Germany
| | - Alena-Lioba Michalowitz
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany
| | - Doris Helbig
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University of Witten-Herdecke, Oberhausen, Germany.,Department of Dermatology and Venereology, HELIOS Klinikum Duisburg, Duisburg, Germany
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7
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Kuntz T, Siebdrath J, Hofmann SC, Baltaci M, Schaller J, Hellmich M, von Goltzheim LS, Assaf C, Oellig F, Michalowitz AL, Helbig D, Kreuter A. Zunahme des atypischen Fibroxanthoms und pleomorphen dermalen Sarkoms: eine retrospektive Analyse vier deutscher Hauttumorzentren. J Dtsch Dermatol Ges 2022; 20:1581-1588. [PMID: 36508370 DOI: 10.1111/ddg.14911_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/14/2022] [Indexed: 12/14/2022]
Abstract
HINTERGRUND UND ZIELE In den letzten Jahren konnten umfassende Erkenntnisse über die Pathogenese, Diagnostik und Behandlung von kutanen Sarkomen, insbesondere des atypischen Fibroxanthoms (AFX) und pleomorphen dermalen Sarkoms (PDS) gesammelt werden. Beide Entitäten zeigten innerhalb der letzten Dekade steigende Inzidenzraten. Die vorliegende Studie diente der Untersuchung, welchen Einfluss die neuen Erkenntnisse auf die Fallzahlen von AFX/PDS im Vergleich zu anderen Sarkom-Entitäten haben. PATIENTEN UND METHODIK Diese retrospektive Studie wurde an vier deutschen Hauttumorzentren durchgeführt und alle von zertifizierten Dermatopathologen bestätigten histopathologischen Befunde von kutanen Sarkomen (AFX, PDS, Dermatofibrosarcoma protuberans, kutanes Leiomyosarkom, Angiosarkom und Kaposi-Sarkom) in einem Zeitraum von sieben Jahren (2013-2019) evaluiert. Zusätzlich wurde der Einsatz von immunhistochemischen Markern als diagnostische Hilfe (Panzytokeratin, S100, Desmin, CD34, CD10, Prokollagen-1, CD99, CD14 und CD68) erfasst. ERGEBNISSE Insgesamt konnten 255 kutane Sarkome in die vorliegende Studie eingeschlossen werden. Die Zahl der kutanen Sarkome nahm kontinuierlich von 2013 bis 2019 zu (von 16 auf 52 Fälle im Jahr). Die Diagnose eines AFX/PDS konnte in 2019 4,6-mal häufiger als in 2013 gestellt werden. Das AFX stellte mit 49,3 % aller kutanen Sarkome den häufigsten Sarkom-Subtypen dar. Zusätzlich war der Anstieg von AFX/PDS mit dem Einsatz von Immunhistochemie assoziiert. Der Einsatz von spezifischen Immunhistochemischen Markern stieg von 57,1 % im Jahr 2013 auf 100 % in 2019. SCHLUSSFOLGERUNGEN Diese retrospektive Studie von vier deutschen Hauttumorzentren demonstriert eine substanzielle Zunahme von AFX/PDS, wahrscheinlich infolge kürzlich etablierter beziehungsweise verbesserter diagnostischer und terminologischer Standards. Dieser Anstieg ist vermutlich mit dem vermehrten Einsatz von bestimmten immunhistochemischen Markern assoziiert. AFX/PDS treten wahrscheinlich häufiger auf als bisher vermutet und repräsentieren möglicherweise den häufigsten kutanen Sarkom-Subtyp.
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Affiliation(s)
- Thomas Kuntz
- Klinik für Dermatologie, Venerologie und Allergologie, Universität zu Köln.,Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Krankenhaus Oberhausen, Universität Witten-Herdecke, Oberhausen
| | - Julian Siebdrath
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Krankenhaus Oberhausen, Universität Witten-Herdecke, Oberhausen
| | - Silke C Hofmann
- Klinik für Dermatologie, Allergologie und Dermatochirurgie, HELIOS Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Wuppertal
| | - Mehmet Baltaci
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Duisburg
| | - Jörg Schaller
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Duisburg
| | - Martin Hellmich
- Institut für Medizinische Statistik und Bioinformatik, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln
| | - Luise Stach von Goltzheim
- Institut für Medizinische Statistik und Bioinformatik, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln
| | - Chalid Assaf
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Krefeld
| | | | - Alena-Lioba Michalowitz
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Krankenhaus Oberhausen, Universität Witten-Herdecke, Oberhausen
| | - Doris Helbig
- Klinik für Dermatologie, Venerologie und Allergologie, Universität zu Köln
| | - Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Krankenhaus Oberhausen, Universität Witten-Herdecke, Oberhausen.,Klinik für Dermatologie und Venerologie, HELIOS Klinikum Duisburg
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8
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Katina MA, Lesnichaya OV, Ryazanova NV. Dermatofibrosarcoma protuberans in dermatological practice. Case report. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.8.201721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a mesenchymal neoplasm of fibrohistiocytic origin of moderate malignancy. The pathogenesis of DFSP involves chromosomal translocation, which leads to the formation of a fusion protein that promotes tumor growth due to increased production of platelet growth factor (PDGF). Clinically, it begins with an asymptomatic fibrous papule or firm plaques, which gradually over the course of several years become enlarged with the formation of asymmetrical multi-nodular structure of purple or red-brown color. The standards of diagnosis is a histological examination with the detection of a poor limited infiltrate indermis of a storiform architecture consisting of monomorphic spindle cells and diffuse CD34+ staining during immunohistochemistry. Complete surgical excision is considered the gold standard of treatment. Clinical case: female patient, 35 years old with a lesion in the form of a dense plaque in right subclavian area was examined by a dermatologist. The primary diagnosis was made as "morphea". In a year a slight growth of the lesion and the appearance of small firm nodules asymmetrically along the periphery were noted. According to the results of histological and immunohistochemistry studies the diagnosis of DFSP was made, the patient was referred to an oncologist for complete tumor removal.
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9
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Serra-Guillén C, Llombart B, Nagore E, Guillén C, Sanmartín O. Determination of Margins for Tumor Clearance in Dermatofibrosarcoma Protuberans: A Single-Center Study of 222 Cases Treated With Modified Mohs Surgery. Dermatol Surg 2022; 48:51-56. [PMID: 34743125 DOI: 10.1097/dss.0000000000003269] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is an invasive skin tumor traditionally associated with very high recurrence rates when treated with conventional surgery (CS). OBJECTIVE To calculate the minimum margin that would have been required to achieve complete tumor clearance with hypothetical CS. To analyze DFSP characteristics and Mohs micrographic surgery (MMS) effectiveness in treatment of this tumor. MATERIALS AND METHODS Minimum margin was calculated by measuring the largest distance from the visible edge of the tumor to the edge of the surgical defect. Tumor variables (age, sex, size, time since onset, and location) were correlated with surgical variables (number of stages and minimum margin). RESULTS We studied 222 cases of DFSP treated with MMS. A mean of 1.47 MMS stages and a mean minimum margin of 1.23 cm were required to achieve tumor clearance. Tumors on the head and neck required significantly more stages and a significantly wider margin. Tumor size was positively correlated with time to diagnosis, age, and number of MMS stages. CONCLUSION Tumors located on the head and neck have greater subclinical extension. Tumor size was also a predictor of surgical difficulty, but time to diagnosis was not.
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Affiliation(s)
| | - Beatriz Llombart
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, Spain
| | - Carlos Guillén
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Onofre Sanmartín
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, Spain
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10
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Dermatofibrosarcoma- An uncommon entity, commonly mismanaged: a case report. Int J Surg Case Rep 2021; 87:106385. [PMID: 34563815 PMCID: PMC8479619 DOI: 10.1016/j.ijscr.2021.106385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/10/2021] [Accepted: 09/02/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction & importance Dermatofibrosarcoma protuberans (DFS) is a slow-growing, recurrent, cutaneous soft tissue sarcoma with low metastatic potential. It is not uncommon for DFS to get misdiagnosed and treated like commoner parietal wall swellings, viz., epidermal cysts, lipomas and fibromas. Suboptimal management often leads to recurrence, which may be difficult to manage. Case report A 33-year male was referred to us with a lump in his lower abdomen for 15 years, without any symptoms. The patient underwent medical management for 6 years, followed by excision. The swelling recurred four years later and progressed in size till the next 5 years. At our centre, the patient underwent imaging and aspiration cytology, which established diagnosis of DFS, followed by wide local excision. Biopsy was conclusive and margins negative. Discussion DFS presents commonly as an asymptomatic indurated plaque that slowly enlarges over months to years. Untreated, DFS can attain massive dimensions, producing the large “protuberant” nodules, and hence the name. In the current report, 15 years elapsed before the correct diagnosis was established. In this case, recurrence first appeared after four years of excision. The possibility of primary wound closure after wide excision decreases with every subsequent excision, and reconstructive options may not be readily available. Conclusion The current report highlights a diagnostic delay of 15 years in a case of DFS. Asymptomatic, indolent nature combined with low awareness among community doctors contribute to delay in timely diagnosis. Community doctors should consider DFS as a differential in any long-standing, indolent, asymptomatic parietal wall swelling, especially with a history of recurrence. It is not uncommon for DFS to get misdiagnosed . Suboptimal management often leads to recurrence, which may be difficult to manage. We report a case that highlights a diagnostic delay of 15 years in the case of DFS. Indolent nature low awareness among doctors contribute to delay in the diagnosis.
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11
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Triki A, Aloui M, Ghalleb M, Jbir I, Naceur B, Hassouna JB, Chargui R, Rahal K. Giant Darier-Ferrand dermatofibrosarcoma protuberans of the abdomen and pelvis: a case report. J Med Case Rep 2021; 15:120. [PMID: 33715634 PMCID: PMC7958428 DOI: 10.1186/s13256-021-02687-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Darier–Ferrand dermatofibrosarcoma (DFS) is a rare malignant cutaneous neoplasm characterized by local aggressiveness, high risk of recurrence, and low metastatic potential. Case presentation A 60-year-old Tunisian man with recurrent abdominopelvic DFS for which he had undergone multiple excisions presented with an extensive DFS that invaded the external genitals. He underwent a large excision with emasculation and thin cutaneous graft of the abdominal wall and local skin flap in the pelvis. Conclusion DFS is a rare yet recurrent skin tumor. Wide excision with free margins remains the cornerstone of treatment. We report a case of a giant DFS treated with wide excision and reconstructive surgery to cover the defect.
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Affiliation(s)
- A Triki
- Surgical Oncology Department, Salah Azaiez Institute of Oncology, Tunis, Tunisia.,Faculty of Medicine, Tunis, Tunisia
| | - M Aloui
- Surgical Oncology Department, Salah Azaiez Institute of Oncology, Tunis, Tunisia. .,Faculty of Medicine, Tunis, Tunisia.
| | - M Ghalleb
- Surgical Oncology Department, Salah Azaiez Institute of Oncology, Tunis, Tunisia.,Faculty of Medicine, Tunis, Tunisia
| | - I Jbir
- Surgical Oncology Department, Salah Azaiez Institute of Oncology, Tunis, Tunisia.,Faculty of Medicine, Tunis, Tunisia
| | - Ben Naceur
- Plastic Surgery Unit, Salah Azaiez Institute of Oncology, Tunis, Tunisia.,Faculty of Medicine, Tunis, Tunisia
| | - J Ben Hassouna
- Surgical Oncology Department, Salah Azaiez Institute of Oncology, Tunis, Tunisia.,Faculty of Medicine, Tunis, Tunisia
| | - R Chargui
- Surgical Oncology Department, Salah Azaiez Institute of Oncology, Tunis, Tunisia.,Faculty of Medicine, Tunis, Tunisia
| | - K Rahal
- Surgical Oncology Department, Salah Azaiez Institute of Oncology, Tunis, Tunisia.,Faculty of Medicine, Tunis, Tunisia
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12
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Garrido Ríos S, Bustos Martínez G, Olaizola Zubicarai MI, Fernández de Misa Cabrera R, A Garrido Ríos A. Dermatofibrosarcoma Protuberans in the Abdominal Wall: Reconstruction with an Anterolateral Thigh Flap. Cir Esp 2020; 98:630-632. [PMID: 32156415 DOI: 10.1016/j.ciresp.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Sofía Garrido Ríos
- Servicio de Cirugía Plástica, Complejo Hospitalario Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Tenerife, España.
| | - Gema Bustos Martínez
- Servicio de Cirugía Plástica, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | | | - Ricardo Fernández de Misa Cabrera
- Servicio de Dermatología, Complejo Hospitalario Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Tenerife, España
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Essid L, Sassi S, Khelil K, Sbai MA, Maalla R. The surgical management of a hypogastric dermatofibrosarcoma protuberans. Pan Afr Med J 2019; 34:116. [PMID: 31934257 PMCID: PMC6945386 DOI: 10.11604/pamj.2019.34.116.17740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 09/24/2019] [Indexed: 11/28/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon skin tumor with intermediate grade of malignancy. Wide surgical resection with disease-free margin offers an excellent probability of cure. These large excisions cause large skin defect that can be difficult to cover. Through this case report we describe a surgically treated DFSP that was covered by a Mc Gregor flap; which despite its seniority is still relevant and continues to serve plastic surgery.
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Affiliation(s)
- Leila Essid
- Orthopaedic and Trauma Department, Maamouri Hospital, Nabeul, Tunisia
| | - Selim Sassi
- General Surgery Department, Maamouri Hospital, Nabeul, Tunisia
| | - Khaled Khelil
- Orthopaedic and Trauma Department, Maamouri Hospital, Nabeul, Tunisia
| | - Mohamed Ali Sbai
- Orthopaedic and Trauma Department, Maamouri Hospital, Nabeul, Tunisia
| | - Riadh Maalla
- Orthopaedic and Trauma Department, Rabta Hospital, Tunis, Tunisia
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Llombart B, Serra C, Requena C, Alsina M, Morgado-Carrasco D, Través V, Sanmartín O. Guidelines for Diagnosis and Treatment of Cutaneous Sarcomas: Dermatofibrosarcoma Protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Llombart B, Serra C, Requena C, Alsina M, Morgado-Carrasco D, Través V, Sanmartín O. Guidelines for Diagnosis and Treatment of Cutaneous Sarcomas: Dermatofibrosarcoma Protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:868-877. [PMID: 30539729 DOI: 10.1016/j.ad.2018.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/21/2018] [Accepted: 05/23/2018] [Indexed: 12/26/2022] Open
Abstract
Sarcomas comprise a broad group of tumors, many of whose biological behavior and aggressiveness differ from one type to another. The therapeutic approach is generally multidisciplinary and often complex. Developments in surgical and oncological dermatology during the last few decades have positioned dermatologists as specialists in the diagnosis and treatment of skin cancer. The aim of this article is to review the main soft tissue sarcomas that typically affect the skin. Dermatofibrosarcoma protuberans is a low-grade malignant sarcoma. It exhibits slow-growth, is locally invasive, and has low metastatic potential (<3%). Mohs micrographic surgery is the treatment of choice. The COL1A1-PDGFB translocation should be analyzed in cases of unclear diagnosis and when it is necessary to identify candidates for tyrosine kinase inhibitors. Imatinib is indicated for the treatment of locally advanced and metastatic dermatofibrosarcoma protuberans.
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Affiliation(s)
- B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - C Serra
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - M Alsina
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - V Través
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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Histologic Features Associated with Deep Invasion in Dermatofibrosarcoma Protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Histologic Features Associated with Deep Invasion in Dermatofibrosarcoma Protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:414-20. [PMID: 26944448 DOI: 10.1016/j.ad.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing cutaneous tumor that can invade the subcutaneous tissue, muscle tissue, and even bone. OBJECTIVE To identify histologic features associated with greater depth of invasion, i.e., local aggressiveness, in DFSP. MATERIAL AND METHODS We analyzed associations between histologic features of DFSP (e.g., type of subcutaneous invasion, histologic pattern, cell type, areas of fibrosarcoma) and the presence and absence of muscle fascia involvement. RESULTS We studied 155 cases of DFSP. The following histologic characteristics were significantly associated with involvement of the muscle fascia: the presence of a sheetlike pattern, a high degree of cellular pleomorphism, and more than 1 mitotic figure. The tumor did not extend beyond the subcutaneous tissue in the majority of cases (62.6%), but there was involvement of the fascia or galea aponeurotica in 17 cases (11%) and of the muscle tissue in 36 cases (23.2%). CONCLUSIONS Histologic patterns, degree of pleomorphism, and number of mitotic figures are important predictors of deep invasion (fascia or muscle) in DFSP; these layers can be involved in up to 30% of cases.
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Serra-Guillén C, Llombart B, Nagore E, Guillén C, Requena C, Traves V, Kindem S, Alcalá R, Rivas N, Sanmartín O. Mohs micrographic surgery in dermatofibrosarcoma protuberans allows tumour clearance with smaller margins and greater preservation of healthy tissue compared with conventional surgery: a study of 74 primary cases. Br J Dermatol 2015; 172:1303-7. [DOI: 10.1111/bjd.13417] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2014] [Indexed: 12/12/2022]
Affiliation(s)
- C. Serra-Guillén
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - B. Llombart
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - E. Nagore
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
- Facultad de Medicina; Universidad Católica de Valencia; Valencia Spain
| | - C. Guillén
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - C. Requena
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - V. Traves
- Department of Pathology; Instituto Valenciano de Oncología; Valencia Spain
| | - S. Kindem
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - R. Alcalá
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - N. Rivas
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - O. Sanmartín
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
- Facultad de Medicina; Universidad Católica de Valencia; Valencia Spain
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Chan TC, Wu CJ, Jeng SF. Dermatofibrosarcoma protuberans: A 10-year experience. FORMOSAN JOURNAL OF SURGERY 2015. [DOI: 10.1016/j.fjs.2014.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Serra-Guillén C, Llombart B, Nagore E, Requena C, Traves V, Llorca D, Kindem S, Alcalá R, Guillén C, Sanmartín O. High immunohistochemical nestin expression is associated with greater depth of infiltration in dermatofibrosarcoma protuberans: a study of 71 cases. J Cutan Pathol 2013; 40:871-8. [PMID: 23962157 DOI: 10.1111/cup.12203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/05/2013] [Accepted: 07/14/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) was recently shown to express nestin, a marker that has been associated with poorer prognosis when present in high levels in certain tumors. The objective of this study is to explore the association between high nestin expression and deep invasion. METHODS We performed a retrospective, observational study in which we evaluated the degree of nestin expression in 71 DFSP. The odds of fascial involvement was calculated before and after adjusting for the following confounders: age, sex, tumor size, time to diagnosis, tumor site, the presence of fibrosarcomatous areas, pleomorphism, number of mitotic figures and predominant histopathologic pattern. We also calculated the Spearman Rho correlation coefficient between nestin staining intensity and depth of invasion. RESULTS Nestin immunopositivity was found in 98.6% of the tumors, and high expression levels were significantly associated with invasion of the fascia. The odds of fascial involvement in tumors with strong nestin staining was 6.56 (p = 0.001) before adjustment for confounders and 14.86 after adjustment (p = 0.007). The Spearman rho correlation coefficient between nestin expression and deep invasion was 0.287 (p = 0.015). CONCLUSION High inmunohistochemical nestin expression appears to be associated with deeper invasion in DFSP.
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Serra-Guillén C, Llombart B, Nagore E, Requena C, Traves V, Llorca D, Kindem S, Alcalá R, Guillén C, Sanmartín O. Positive margins in excised dermatofibrosarcoma protuberans: a study of 58 cases treated with slow-Mohs surgery. J Eur Acad Dermatol Venereol 2013; 28:1012-5. [PMID: 23931335 DOI: 10.1111/jdv.12235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 07/11/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is characterized by unpredictable subclinical extension, meaning that positive margins are frequently detected following conventional surgical excision. OBJECTIVE To study the presence or absence of residual tumour in DFSP with positive margins after conventional surgery and identify possible predictors of residual tumour or clear margins following a single Mohs micrographic surgery (MMS) stage. METHODS A retrospective study of patients with DFSP and positive margins following conventional excision referred for MMS was performed. We studied gender, age, tumour site, time from presentation to diagnosis, and affected margins. RESULTS We studied 58 cases, 35 (60.3%) of which had histological evidence of residual tumour. Tumours of the head and neck were significantly associated with the persistence of tumour. A single MMS stage was sufficient to achieve clearance in the majority of cases (n = 46). All tumours with lateral involvement only were resolved with a single Mohs stage. CONCLUSIONS DFSPs with positive margins after conventional surgical excision should undergo re-excision because the majority have histologic evidence of residual tumour. Re-excision with 1-cm margins beyond the scar could be an option in certain tumour sites, particularly when it is known which margins are involved.
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Affiliation(s)
- C Serra-Guillén
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia
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